Innervation of nociceptors in the menisci of the knee joint: an immunohistochemical study

Using histology, we studied the innervation of nociceptors in the medial and lateral menisci of the knee joint. Specimens examined were taken from 16 patients during arthroplasty. The patients were 6 men and 10 women, with ages ranging from 14 to 76 years (mean 56 years). Immunohistochemistry with the unlabeled antibody biotin-streptavidin method was employed to detect protein gene product 9.5 (PGP 9.5) or substance P (SP) in the specimen. The antibody for PGP 9.5 detected nerve tissues in the menisci. Most but not all of the nerve fibers were associated with blood vessels. Nerve fibers and sensory receptors were found mainly in the peripheral, vascular zone, representing the outer one-third of the meniscus, and the innervated area was wider in the anterior and posterior horns. Pacinian and Ruffini corpuscles as well as free nerve endings were identified in these areas. Larger fibers coursed circumferentially in the peripheral zone, with smaller branches of nerve fibers running radially into the meniscus. Nerve fibers positive for SP were also detected in the menisci, but were fewer in number. Their branches also were fewer, oriented radially and paralleling blood vessels. This study showed that some of the pain in cases of meniscal tear could originate in the meniscus itself, especially with peripheral tears that may be accompanied by bleeding. Received: 2 June 1998     

An immunohistochemical study of osteopontin in hepatolithiasis

Background/Purpose  Mucin glycoprotein from the intrahepatic bile ducts, and from the intramural and extramural glandular epithelia, is thought to contribute to the formation of the matrix, or nucleus, in hepatolithiasis and to contribute to biomineralization systems. Osteopontin (OPN), a noncollagenous acidic bone matrix glycoprotein that possesses calcium-binding properties. To investigate the role of OPN in the genesis of hepatolithiasis, OPN was immunohistochemically studied in the intrahepatic bile ducts, intramural and extramural glands, and in stones. Methods  An immunohistochemical study was performed in 21 human liver specimens with hepatolithiasis, by the EnVision (Dako Japan, Kyoto, Japan) method. Results  Staining for OPN was strongly positive in the epithelium of stone-laden intrahepatic bile ducts, intramural and extramural glands, and in stones. The stone-laden intrahepatic bile ducts were infiltrated by macrophages showing intense staining for OPN. Sections of the hepatolithiasis, viewed under low magnification, showed a lamellar pattern of OPN immunolabeling, and they showed a reticular pattern under high magnification. In the center of the stones, large nestlike membranous structures were frequently present. Conclusions  Our result indicates that OPN, an acidic glycoprotein from intrahepatic bile ducts and from intramural and extramural glandular epithelia, seems to be involved in lithiasis, both as a core protein in the early phase, and in the late phase.     

An electron microscopic study of early pathology in chondromalacia of the patella

For a study of the ultrastructural pathology of chondromalacia patellae, we studied biopsy specimens that had been obtained at operation in twelve young patients who had pain in the anterior aspect of the knee due to mechanical derangement and also had the pathological changes in articular cartilage that are characteristic of chondromalacia. The initial pathological finding was swelling of the superficial matrix associated with breakdown of the collagen fiber network, especially at matrix streaks in the superficial and transitional zones. Fibrillated cartilage contained surface fissures that penetrated the middle layers. Amorphous electron-dense material was found covering the internal surfaces of the fissures; this appeared to contain degraded components of the matrix. In association with these changes, there were formation of nests of cells (clusters of chondrocytes) and increased numbers of organelles in the chondrocytes. A limited repair reaction also was observed in some specimens; this was characterized by the migration of fibroblast-like cells over the surface of the cartilage. The ultrastructural observations on these specimens from patients who had chondromalacia were compatible with a pathogenesis resulting from mechanical overload.     

免疫组化方法研究女性胎儿尿道括约肌的神经支配

目的探讨支配女性尿道括约肌神经纤维的定位、定量及定性。方法12例21周至40周的女性胎儿尿道,分别进行石蜡包埋、胆碱乙酰基转移酶（choline acetylcatransferase,CHAT）及神经肽Y（neuropeptide Y,NPY）免疫组化染色,并对其结果进行半定量和定量分析。结果从尿道内口至外口,神经肽Y阳性区域显色范围逐渐变小、强度减弱,胆碱乙酰基转移酶阳性区域主要位于尿道中三分之一,统计学上具有显著性差异。结论尿道括约肌的胆碱乙酰基转移酶及神经肽Y免疫组化染色对理解参与控尿的尿道括约肌神经支配提供了很有价值的帮助。     

Innervation of the female human urethral sphincter: 3D reconstruction of immunohistochemical studies in the fetus

OBJECTIVES: The precise location, origin and nature of nerve fibers innervating the urethral sphincter have not been clearly established. Classical anatomical studies based on cadaver dissections have provided conflicting results concerning the location of pudendal and autonomic nerve fibers. This study was designed to identify nerve fibers innervating the urethral sphincter and to provide a three-dimensional representation of their tissue relations in the female human fetus. MATERIALS AND METHODS: Histology and immunohistochemistry (Masson's Trichromic, Luxol Fast Blue, Protein S 100 immunostaining and smooth fiber actin immunostaining) were performed on the external urethral sphincter of ten female fetuses with a crown-rump length of 112 to 340mm. Three-dimensional reconstructions of the urethral structure and innervation were obtained from serial sections using Surf Driver 3.5.3 software (David Moody and Scott Lozanoff). RESULTS: Three-dimensional reconstructions of the same sections with different stains demonstrated the precise structure of the muscle layers (smooth and striated muscle fibers) and nerve fibers (myelinated and unmyelinated) and their relations with the urethra and vaginal wall. The proximal third consisted of a circular smooth muscle sphincter, the middle third consisted of two circular layers of smooth and striated muscle fibers and the distal third consisted of a circular layer of smooth muscle fibers surrounded by an omega-shaped layer of striated muscle fibers. In the proximal third of the urethral sphincter, myelinated fibers were identified running with unmyelinated fibers from the pelvic plexus. These fibers were closely related to the lateral and anterior aspects of the vagina. Unmyelinated fibers entered the smooth muscle part of the sphincter at 4 o'clock and at 8 o'clock. Most myelinated fibers entered the sphincter at 3 o'clock and at 9 o'clock. CONCLUSION: Histological and immunohistochemical three-dimensional reconstruction of the anatomical structures of the urethral sphincter provides a better understanding of the origin and nature of the Innervation participating in urinary continence. It provides a very informative view of the three-dimensional arrangement of sphincter muscle layers.     

Vastus lateralis fibrosis in habitual patella dislocation: An MRI study in 28 patients

We studied 28 patients with habitual or recurrent dislocation of the patella with MRI of both thighs. Apart from the 2 patients whose dislocation could be related to trauma, we found signs of fibrosis of the vastus lateralis muscle in all the affected limbs of the 26 patients with an insidious onset of dislocation. This was seen as low signal intensity cords in the muscles in the T2 weighted image. Muscle degeneration was seen as high intensity signals in the T1 weighted image. In patients with unilateral disease, the vastus lateralis muscle of the affected side was hypotrophic, compared to that of the normal side. 2 patients underwent a biopsy of the affected muscle area. Histopathological examination revealed inflammatory cell infiltration, fibrosis, and muscle fiber degeneration. Fibrosis of the vastus lateralis muscle appears to be common in patients with habitual patella dislocation in our population, and may be the cause of the dislocation. Since release of such a contracture may be of value, MRI study of the thigh muscles is helpful in the evaluation of patients with this disorder.     

Vastus lateralis fibrosis in habitual patella dislocation: An MRI study in 28 patients

We studied 28 patients with habitual or recurrent dislocation of the patella with MRI of both thighs. Apart from the 2 patients whose dislocation could be related to trauma, we found signs of fibrosis of the vastus lateralis muscle in all the affected limbs of the 26 patients with an insidious onset of dislocation. This was seen as low signal intensity cords in the muscles in the T2 weighted image. Muscle degeneration was seen as high intensity signals in the T1 weighted image. In patients with unilateral disease, the vastus lateralis muscle of the affected side was hypotrophic, compared to that of the normal side. 2 patients underwent a biopsy of the affected muscle area. Histopathological examination revealed inflammatory cell infiltration, fibrosis, and muscle fiber degeneration. Fibrosis of the vastus lateralis muscle appears to be common in patients with habitual patella dislocation in our population, and may be the cause of the dislocation. Since release of such a contracture may be of value, MRI study of the thigh muscles is helpful in the evaluation of patients with this disorder.     

斜方肌神经支配的应用解剖学研究

目的　对斜方肌的神经支配进行解剖学研究 ,为在有关手术中保留部分斜方肌的功能提供可靠的依据。方法　取 2 0具中国成年人尸体 ,在头戴式放大 5倍显微镜下 ,解剖观察 40侧斜方肌的神经支配及其行径。结果　斜方肌的神经支配来源于副神经占 10 0 % ;来源于 C2～ 4神经根及 C5 神经根 ,分别占 10 0 %、45 %。副神经平均直径为 2 .18± 0 .2 3mm(x± sx,下同 ) ;颈神经根的分支一般在斜方肌血管神经门以前加入副神经后进入斜方肌 ,或直接进入斜方肌。副神经在肩胛冈中点附近及上方 2 .6 cm处分成二支支配斜方肌的上下两部分。结论　 40块斜方肌均受副神经的支配和 C2～ 4神经根直接或间接的支配 ,部分斜方肌受 C5 神经根直接或间接的支配。在副神经移位及斜方肌肌瓣手术中可利用部分斜方肌及副神经在斜方肌中的一个分支 ,使供区可保留部分斜方肌的功能     

Collagen type III in rotator cuff tears: An immunohistochemical study

The presence and distribution of collagen type III, which represents newly formed fibers of early repair, were investigated in four surgically removed en bloc specimens of complete rotator cuff tears. The patients were two men and two women who ranged in age from 63 to 71 years. They had received preoperative, conservative treatment for a period varying from 3 months to 3 years. For the identification of the collagen immunohistochemical staining was performed by the peroxidase-antiperoxidase method with the use of monoclonal antibody against human collagen type III. Collagen type III was discernible throughout the tendon proper in all specimens. It often occurred in association with proliferating fibroblastic cells. Collagen type III was abundant only in the perivascular spaces of the much thickened bursal wall that extended over the margins of the tear. We concluded that the presence of collagen type III indicates the need for a continued attempt for repair at the site of the tear, including both bursal and tendinous tissues.     

Keratin in epithelioid sarcoma. An immunohistochemical study

Intermediate-sized filaments have been noted in epithelioid sarcoma by previous investigators, two of whom have reported that the filaments represent vimentin. We utilized polyclonal antibodies directed against keratin and immunoperoxidase techniques (PAP) to stain 32 of the more than 300 cases accumulated at the AFIP . All of our material was formalin-fixed, paraffin-embedded. Seventy-five percent of our cases (24/32) showed positive immunoreactivity, a feature that may be of diagnostic help in distinguishing epithelioid sarcoma from modular fasciitis, benign and malignant fibrous histiocytoma, malignant melanoma, and necrotizing granuloma. In these cases, the reaction was enhanced using predigestion with trypsin. The immunoreactivity varied from tumor to tumor, perhaps due to formalin fixation. Since synovial sarcoma and mesothelioma may also be cytokeratin-positive, our findings indicate that keratin immunoreactivity is not confined to epithelial tumors and may also occur in neoplasms traditionally regarded as mesenchymal.     

Arthroscopic patella realignment: An all-inside technique

Purpose: Many methods of realigning the patella have been described. Most techniques for proximal realignment involve an open medial reefing or advancement of the vastus medialis obliquus. Arthroscopically assisted methods have been described, but these all involve the need for a medial incision to tie sutures. This article describes an entirely arthroscopic technique for proximal realignment that eliminates the need for an incision, and reports the 2-year follow-up results using this technique. Type of Study: Retrospective review. Methods: Over a 5-year period, 26 patients (29 knees) with patellar instability were treated with an outpatient arthroscopic all-inside medial reefing and lateral release. Arthroscopic reefing was performed by percutaneous passage of suture followed by arthroscopic retrieval and knot tying inside the joint. Before knot tying, a healing response was initiated along the medial retinaculum by either gentle shaving with a whisker blade or by radiofrequency thermal response. Rehabilitation consisted of 1 week of immobilization followed by an accelerated program of range of motion exercises and vastus medialis obliquus strengthening. Results: At follow-up, 93% of patients reported significant subjective improvement. The average Lysholm score improved from 41.5 to 79.3 (P < .05). Preoperative and postoperative radiographs were measured for congruence angle, lateral patellofemoral angle, and lateral patella displacement, and all showed significant improvement postoperatively (P < .05). There were no complications and no redislocations. Patients reported a significant improvement in pain, swelling, stair climbing, crepitus, and ability to return to sports (P < .05). Conclusions: Arthroscopic patella realignment is a viable technique that offers results comparable or superior to published results for open or arthroscopically assisted realignment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 940–945     

Immunoproliferative small-intestinal disease. An immunohistochemical study

We performed a detailed histological and immunohistological study on both fresh-frozen and paraffin-embedded tissue from full-thickness jejunal biopsy specimens taken from three patients with immunoproliferative small-intestinal disease (IPSID). In all three patients, the mucosal infiltrate consisted of "centrocyte-like" (CCL) cells forming lymphoepithelial lesions and plasma cells. In one patient, the mucosal infiltrate was strikingly follicular. Immunohistochemistry showed alpha 1 heavy chain, but no light chain, in the perinuclear space and cytoplasm of the CCL cells and in the plasma cells. In two patients, the plasma cells (but not the CCL cells) also contained alpha 2 heavy chain. In the case showing a follicular pattern, the extrafollicular CCL cells and most of the cells within the mucosal follicles expressed alpha 1 heavy chain, but a minor and variable population of cells expressed polytypic IgM. The dendritic reticulum cells stained for alpha 1 (but not alpha 2) heavy chain, mu chain, and both light chains. In all cases, the CCL cells did not stain for common acute lymphoblastic leukaemia antigen (CALLA); in the follicles, CALLA negative cells displaced a residual CALLA-positive population to the periphery and merged with the CALLA negative cells outside the follicles. These findings confirm the homology between IPSID and low-grade B-cell "Western" lymphomas arising in mucosa-associated lymphoid tissue; they suggest that the follicular pattern sometimes seen in these lymphomas is caused by selective colonization of reactive follicles by CCL tumor cells.     

肾癌异型性的免疫组化研究

为了探讨肾癌的异型性，对４２例肾癌应用抗ＣＤ_（１５）、抗上皮细胞膜抗原（抗ＥＭＡ）、抗神经元特异性烯醇化酶（抗ＮＳＥ）三种单抗，采用免疫组化ＡＢＣ法联合检测进行分类。肾癌Ａ型（＋、－、－）表达９例，分化好、异型性小、预后最好；肾癌Ｃ型（－、＋、＋）表达１３例，分化差、异型性大、预后最差；其余为Ｂ型，介于Ａ型和Ｃ型之间。结果提示肾癌ＣＤ_（１５）、ＥＭＡ、ＮＳＥ的表达与否，可表明癌细胞是否保留近曲小管上皮细胞的抗原性，可作为判断肾癌异型性的一个指标，与患者预后有关。     

An immunohistochemical study of intracranial germ cell tumours

Summary Histologically verified intracranial tumours, mainly germ cell tumours of the pineal and suprasellar regions, were studied immunohistochemically using anti-serum of alpha fetoprotein (AFP), human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA), human placental lactogen (HPL), pregnancy specific -1 glycoprotein (SP-1), glial fibrillary acidic protein (GFAP), S-100 and neuron specific enolase (NSE). In germinomas, HCG positive cells were occasionally demonstrated in cells presenting as syncytiotrophoblastic giant cells (STGC), and GFAP and S-100 positive cells were found in the surrounding gliotic lesions. Teratomas were positive for CEA in their epithelial components. Endodermal sinus tumours were positive for AFP, choriocarcinomas for HCG and SP-1, and embryonal carcinomas for AFP, HCG and SP-1. HCG and SP-1 positive cells were demonstrated in STGC. As for the relationship between serum AFP level and tissue localization, many cases presenting a serum AFP level exceeding 220 ng/ml were positive for AFP in tumour tissue.     

An immunohistochemical study of developing glomeruli in human fetal kidneys

BACKGROUND: In the glomerulonephritis, mesenchymal cells frequently repeat the expression of fetal immunohistochemical phenotypes. However, in human glomerulogenesis the phenotypic alteration of mesangial and other types of glomerular cells has not been clearly defined. Our aim was to clarify the characteristics of fetal mesangial cells and glomerular capillary endothelial cells, as well as their changes during glomerulogenesis using immunohistochemistry. METHODS: We examined the renal tissues of 34 autopsied fetuses and neonates, 5 children, and 5 adults using immunohistochemistry and immunoelectron microscopy, using antibodies for cytoskeletons, contraction-associated proteins, and endothelial cell markers. RESULTS: In the V and S stages, there were no cells showing mesangial and endothelial features within the vesicles and the S-shaped bodies. In the S stage, small blood vessels, consisting of endothelial cells (CD31+, CD34+) and primitive perivascular mesenchymal cells (alpha-smooth muscle actin+, low molecular caldesmon+, vimentin+), were branched from developing interlobular arteries and appeared to extend to the lower clefts of the S-shaped bodies. In the C stage, the perivascular mesenchymal cells aggregated at the root of the immature glomeruli. In the M stage, they migrated toward the periphery of immature glomeruli and gradually lost their fetal immunohistochemical features. Similarly, with further maturation, the fetal glomerular capillary endothelial cells gradually lost the immunostaining for CD34, while the strong staining intensity of CD31 remained unchanged, just as that in the adult glomerular capillary endothelial cells. CONCLUSIONS: In human glomerulogenesis, we demonstrate that fetal mesangial and capillary endothelial cells change their immunohistochemical phenotypes with maturation. They gradually lose fetal immunohistochemical phenotypes. Already before birth, the mesangial cells in almost all glomeruli at the late M stage acquire the adult phenotype.     

Proliferative myositis. An immunohistochemical and ultrastructural study

We studied four cases of proliferative myositis by the avidin-biotin-peroxidase complex technique, using a panel of 12 antibodies, and by electron microscopy. The aim was to clarify the nature of their constituent cells, specifically the giant ganglion-like cells and spindle cells, and to discuss the implications for histogenesis. In all cases, both cell types showed positive cytoplasmic staining with antibodies to vimentin, actin (C4), and alpha-smooth muscle actin-1, but in only one was there positive staining with desmin. No staining was obtained with factor XIIIa, muramidase, alpha-1-antitrypsin, myoglobin, S-100 protein, CAM 5.2, factor VIII-related antigen, or neuron-specific enolase. By electron microscopy, both types of cells were seen to contain numerous thin filaments, dense bodies, coated and pinocytotic vesicles, active and dilated rough endoplasmic reticulum, few microvilli, and incomplete desmosomal junctions. Our findings imply a myofibroblastic nature for the giant ganglion-like cells and spindle cells. Our observations also support the hypothesis that they are derived from a pericytic cell.